熊去氧胆酸对婴儿肝炎综合征炎症细胞因子的影响

Effects of ursodeoxycholic acid on proinflammatory cytokines in children with infantile hepatitis syndrome

目的：观察熊去氧胆酸治疗婴儿肝炎综合征的临床疗效，并初步探讨其药理机制。方法：选择76例婴儿肝炎综合征患儿为研究对象，根据治疗方法不同分为常规治疗组及熊去氧胆酸治疗组，另选择同期门诊体检健康儿童20名作为对照组。常规治疗组给予抗病毒、护肝等治疗，熊去氧胆酸治疗组在常规治疗组基础上加用熊去氧胆酸（10 mg？ kg－1？ d－1），疗程为2～3周。治疗2周后，比较常规治疗组和熊去氧胆酸治疗组治疗前后血清总胆红素（TBIL）、直接胆红素（DBIL）、谷丙转氨酶（ALT）、谷氨酰转肽酶（GGT）、总胆汁酸（TBA）和TNF－α、IL－6的变化情况。结果：（1）婴儿肝炎综合征患儿血清TNF－α和IL－6均明显高于对照组（P＜0．01）。（2）常规治疗组患儿治疗后血清TBIL、DBIL、ALT、GGT、TBA及TNF－α和IL－6均较治疗前下降，差异有统计学意义（ P＜0．01）。（3）熊去氧胆酸治疗组患儿治疗后血清TBIL、DBIL、ALT、GGT、TBA及TNF－α和IL－6均较常规治疗组显著降低，差异有统计学意义（P＜0．01）。结论：在常规治疗基础上加用熊去氧胆酸能更有效减轻婴儿肝炎综合征患儿全身炎症反应，减轻肝脏损伤。

AIM：To observe the effect of ursodeoxycholic acid （ UDCA） on the treatment of infantile hepatitis syndrome （ HIS） and to investigate its mechanism.METHODS：The children with infantile hepatitis syndrome were divid-ed into conventional treatment group and the UDCA treatment group.Twenty healthy children were selected as normal con-trol.The children in conventional therapy group were given antiviral and hepatoprotective treatments.The children in UD-CA treatment group were given ursodeoxycholic acid （10 mg？ kg-1？ d-1 ） in addition to the conventional treatment group for 2 to 3 weeks.The levels of total bilirubin （TBIL）, direct bilirubin （DBIL）, alanine aminotransferase （ALT）, glu-tamyltransferase （ GGT） , total bile acids （ TBA） and TNF-α, IL-6 were detected before admission and 2 weeks later.RE-SULTS：The levels of TNF-αand IL-6 were significantly higher in the children with IHS than those in the normal control （P〈0.01）.The levels of TBIL, DBIL, ALT, GGT, TBA, TNF-αand IL-6 in conventional treatment group were reduced after therapy （P〈0.01）.All the above index in UDCA treatment group were decreased compared with conventional treat-ment group （P〈0.01）.CONCLUSION：On the basis of conventional therapy, ursodeoxycholic acid effectively alleviates the systemic inflammatory response in the children with IHS, reduces the liver damages.